Restoration of valvular function of deep veins in lower-limb varicose disease

Pokrovsky A.V.^1,2, Gradusov E.G.², Ignatiev I.M.³, Akhmetzyanov R.V.³

1) Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health of the Russian Federation,
2) Russian Medical Academy of Postgraduate Education, Moscow, Russia,
3) Course of Cardiovascular Surgery, Interregional Clinical and Diagnostic Centre, Kazan State Medical University, Kazan, Russia

The present work was based on analysing the results of a complex examination and surgical treatment of 16-to-78-year-old patients presenting with varicose disease during the period from 2006 to 2010. A total of 1,095 limbs were examined and operated on in 1,070 patients. Of these, 298 (29.6%) were men, and 709 (70.4%) women. The distribution of the patients according to the CEAP clinical classification was as follows: C1 – 3 patients, C2 – 215, C3 – 566, C4 – 203, C5 – 29, and C6 – 79 subjects. All patients underwent ultrasonic duplex scanning, with retrograde phlebography performed in 21 cases. 51.2% of patients were diagnosed as having pathological deep venous reflux. In the group of patients with valvular insufficiency of deep veins, a total of 93 operations aimed at correcting deep reflux were performed, including 12 interventions for congenital avalvulation of veins. The indications for restorative operations on the valvular apparatus of deep veins were determined in severe forms of chronic venous insufficiency combined with axial reflux along deep veins in cases of inefficiency of conventional methods of surgical and conservative treatment. The long-term outcomes of surgery were assessed after 18-48 months. The results were evaluated by means of clinical and instrumental methods of examination: the disease severity scale, patients’ quality of life questionnaire, ultrasonographic and roentgen contrast methods of examination, and legometry. The operations aimed at restoring the valvular function of the femoral veins turned out to be effective methods of correcting venous reflux and made it possible to restore the valvular function in 84% of cases. In the remote postoperative period valvular competence was observed in 74.6% of patients. Carrying out such operations significantly improve the course of the disease due to decreasing the malleolar volume (p<0.001), manifestations of symptoms of chronic venous insufficiency (p<0.001), and improving quality of life (p<0.001).

KEY WORDS: valvular insufficiency of deep veins, chronic venous insufficiency, valvuloplasty, avalvulation of deep veins, formation of single-leaf valve.

P. 89

« Back